Green Room

A Critique of “10 Myths About Canadian Health Care, Busted”

The “Health Care Debate” is just about the largest national debate I have ever witnessed. Opinions, facts, figures, lies, misdirection, and propaganda are flying about like trailer parts in a tornado. Both sides are guilty of spewing mis-information, however, since I check all claims, I would say that the bulk clearly comes from the proponents for a national health care plan. As an example, I offer 10 Myths About Canadian Health Care, Busted. This blogpost has been passed around on Twitter by NHC supporters, and it is anything but balanced. Insults begin by the second sentence and condescension drips through the entire piece. Let’s take a look at the mythbusting of Sara Robinson.

1. Canada’s health care system is “socialized medicine.”
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.

The proper term for this is “single-payer insurance.” In talking to Americans about it, the better phrase is “Medicare for all.”

Ms. Robinson defines socialized medical systems, declares that Canada does not have one, then proves that they do by her own definition. You work for who ever pays you. The doctors in Canada get paid by the insurer, which “is the provincial government”. That they “run their own private practices” is irrelevant. If the government pays the doctors, then the doctors work for the government, therefore her first “myth” is true.

2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:

It cannot be a “busted myth” if the answer is “True and False”. Doctors in Canada either make less or they do not. Since their overhead is included in what they make, what we need to find is the average take home pay for doctors of both countries, something Ms. Robinson fails to include.

From 2003 – 2006, the average income from 59 specialty fields in the U.S. was about $299,850. This is income after expenses, but before taxes (source). Data on Canadian doctors is tougher to find, but from what I gleaned from this source , here, and here the average appears to be around $185,500. Of course, there are differences by area in both countries, and salaries vary widely by specialty as well. But, overall, U.S. doctors receive over $100,000 more per year in compensation than the Canadians. This explains why so many Canadian doctors move to the U.S. to practice (several sources estimate the number at close to half).

Ms. Robinson’s next three paragraphs are purely subjective, and speculative, and are thus irrelevant banter, though she is correct that Canadian doctors spend far less time in administrative work and that getting paid is fairly painless by American standards. The next point she makes is about the average debt medical students have by the time they begin working. Again, she has completely made up, and left off, key figures.

Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor’s debt is roughly half that.

Relevant information can be found again from MedPageToday.com:

A medical education is a costly affair on both sides of the border.

According to the American Medical Association, doctors, on average, leave medical school owing about $140,000.

Canadian figures are similar, according to the physician survey in 2007, although varying exchange rates make comparisons difficult. The year 2007 is particularly hard because the Canadian dollar rose from 85 cents U.S. in January to $1.02 at the end of December. At this writing, the Canadian dollar is worth 93 cents in the U.S.

Of the more than 1,000 third- and fourth-year medical students who took part in the survey, 27% expected debt between $60,000 and $100,000 by the time they finished medical school and an additional 31% expected their debt to be more than $100,000.

While exchange rates have been up and down over the past few years, those figures probably represent a slight advantage for Canadian doctors.

On the other hand, in a separate 2007 survey, the Canadian Association of Interns and Residents found that residents owed an average of $158,728.

So, the debt difference is negligible. Next, Robinson mentions another irrelevant fact to her overall point. Malpractice insurance is lower in Canada, but since our pay is based after expenses, the conclusion is unchanged. Same debt, lower pay, higher taxes, Canadian doctors are definitely worse off. On this point I would like to add that Tort Reform, while necessary, is not even close to the “silver bullet” many opposed to universal health care would like it to be. CBO numbers state that a savings from some sort of national reform might save about 3-4% overall – not even close to what could be saved from simply recovering money wasted through medical insurance fraud, especially in the government programs.

3. Wait times in Canada are horrendous.
True and False again — it depends on which province you live in, and what’s wrong with you. Canada’s health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces don’t plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that’s just as true in any rural county in the U.S.

Robinson really doesn’t seem to be selling herself too well. She also provides no data to support her claim. In 2004-5 the Canadian government thought that wait times were bad enough to dump $4.5 billion into a new program designed to reduce them. The First Minister’s words in 2004:

Foremost on this agenda is the need to make timely access to quality care a reality for all Canadians. First Ministers remain committed to the dual objectives of better management of wait times and the measurable reduction of wait times where they are longer than medically acceptable.

So there is a problem, the Canadians know about it. While I don’t live in a rural area, I also do not live in a very large city either. I have been treated for a variety of ailments and seen multiple specialists from internal medicine to cardiologists and neurologists. Never have I had to wait more than a week for an appointment to see any doctor or have any test done. If I did, most likely it was a self-imposed scheduling conflict. I also have never waited more than 30 minutes for any appointment. In fact, my only long waits have been at a Doc-in-a-box which is walk-ins only. Limited resources, plus high demand will either drive up prices, limit access (longer waits) or both. There is no other possible outcome. In Canada there are fewer doctors per capita than in the U.S. (2005 numbers show 2.4 per 1000 in the U.S., 2.2 per 1000 in Canada). There are fewer high-tech machines such as MRI’s. Since pricing is controlled by the government, wait times in Canada must increase. There is no other possible outcome.

Robinson’s points 4 and 5 are not really problems often debated, not by anyone serious anyway. Moving on to number 6 she states is true, so she misnamed the title of her piece. The interesting thing is that with all of the talk of Canada’s wonderful socialized medical system, and their high taxes, people still must come out of pocket for their care. The employer contribution is still out of pocket, you just never see it, so let’s not let that cloud the debate. Granted, the fee for top-notch coverage is small, about $100/month per person, but it is there. My own insurance is just over twice that, my taxes are significantly lower, and I don’t have to wait. Hmmm…

If anyone ever says that Canadian drugs are not the same as American drugs, they are obviously making stuff up. The average person should know that without being told, so her 7th point is also irrelevant. Her 8th point about rationed care may not be true in Canada – but no one is claiming that. The people designing the health care bills here are on record as stating that the elderly must give way to pay for health care for those with more years ahead of them. So, Robinson is confusing a critique of what our version of UHC would look like.

Her 9th point is also more a critique of Americans than the Canadian system. Americans are no where near as good at taking care of something they did not pay for themselves. Most would eat all of the greasy burgers and fatty foods we could get our hands on if we know that the Lipitor and angioplasty will always be free. We invented the hot dog, pizza, and still have yet to find something we can’t throw bacon on to. Yet, having said that, I have seen a surge in people at least trying to be healthier. This is good news for everyone, but especially their families.

On the other hand, Canadians do get a couple more prescriptions filled each year than we do in America (12 to 10.6), and yet there is no national drug coverage. About 2/3 of Canadians purchase prescription drug coverage, and one study found that as many as 20% of Canada’s sicker citizens did not fill prescriptions due to the cost (source). Yes, the prices are lower there, from 1/3 – 1/2 the price of the same drug here. A large part of that is Mediare/Medicaid being legally prevented from negotiating prices with drug companies, though I’m sure there are other reasons as well, probably due to supply chain costs.

Robinson closes with a “myth” about Canadian taxes, and the financial strength of their system. The taxes are higher (this blog post has a good explanation), sure, but ours would actually skyrocket if Medicare and Medicaid’s unfunded liabilities (around $50 Trillion) were included in the budget and dealt with properly. Canada as a country spends about half as much as we do on medical expenses, both as a percentage of GDP and on a per-capita basis. But this is not a critique of our system. Spending more is not necessarily a bad thing. We spend more for houses, cars, TV sets, and popcorn than any other country in the world as well. Sure, we would all like health care to be cheaper, but we want EVERYTHING to cost less. If we didn’t, Wal-Mart would never have grown to the superpower it is.

On another note, Americans have a long history of individualism coupled with a strong sense of “helping our neighbor”. What we do not have is a sense that our private actions may impact our fellow Americans financially. If I fall off a ladder cleaning my gutters and break my arm, I, and my insurance company, are responsible for the costs. I may impact my own insurance rate with risky behavior, but I do not make the costs go up to fellow citizens. Those who do not pay into the system, such as illegal aliens, they help make my insurance rates go up by taking advantage of our system. There is no philosophical difference between that and Wal-Mart raising prices of good slightly to make up for items stolen from their shelves each year. Theft is theft. Now, granted, there are people who need care and cannot afford it. We should never be callous enough to deny care to the destitute. But there also must be reasonable limits to that generosity and one limit must be citizenship unless the patient’s life is in immediate jeopardy.

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It is not surprising that they can’t bust the “myths” about Canadian health care. The truth is not prone to being busted. It doesn’t stop them from planting a misleading title on the effort to lie, though. It’s classic Orwellian Newspeak. Truth is Myth. Repeat the lie until it is believed.